<%@page import="com.myapp.actions.client.GetClient"%>
<%@page contentType="text/html" pageEncoding="UTF-8"%>
<%@taglib prefix="mw" uri="/WEB-INF/tlds/myweb" %>
<mw:action action="<%=new GetClient()%>" result="result"/>
<!DOCTYPE html>
<!--[if lt IE 7]>      <html class="no-js lt-ie9 lt-ie8 lt-ie7"> <![endif]-->
<!--[if IE 7]>         <html class="no-js lt-ie9 lt-ie8"> <![endif]-->
<!--[if IE 8]>         <html class="no-js lt-ie9"> <![endif]-->
<!--[if gt IE 8]><!--> <html class="no-js"> <!--<![endif]-->
  <head>
    <title>CliniQ</title>
    <%@include file="/commons/head.jsp" %>
    <link rel="stylesheet" href="${path}/css/vendor/datepicker.css">
  </head>
  <body>
    <%@include file="/commons/navbar.jsp" %>
    <div class="container">
      <form id="client-detail" class="form-horizontal">
        <input type="hidden" name="id" value="${result.id}" id="id">
        <div class="control-group">
          <label class="control-label" for="lastName">Last Name</label>
          <div class="controls">
            <input type="text" name="lastName" value="${result.lastName}" id="lastName" placeholder="Last Name">
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="firstName">First Name</label>
          <div class="controls">
            <input type="text" name="firstName" value="${result.firstName}" id="firstName" placeholder="First Name">
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="middleName">Middle Name</label>
          <div class="controls">
            <input type="text" name="middleName" value="${result.middleName}" id="middleName" placeholder="Middle Name">
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" >Sex</label>
          <div class="controls">
            <label class="radio inline">
              <input type="radio" name="sex" value="MALE" ${result.sex == "MALE" ? "checked='checked'":""}>
              Male
            </label>
            <label class="radio inline">
              <input type="radio" name="sex" value="FEMALE" ${result.sex == "FEMALE" ? "checked='checked'":""}>
              Female
            </label>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="birthdate">Birthdate</label>
          <div class="controls">
            <div class="input-append date" id="birthdate-dp" data-date="${result.getBirthdate("yyyy-MM-dd")}" data-date-format="yyyy-mm-dd">
              <input id="birthdate" name="birthdate" size="16" type="text" value="${result.getBirthdate("yyyy-MM-dd")}" readonly="readonly">
              <span class="add-on"><i class="icon-calendar"></i></span>
            </div>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="contactInfo">Contact Information</label>
          <div class="controls">
            <input type="text" name="contactInfo" id="contactInfo" value="${result.contactInfo}" placeholder="Contact Information">
          </div>
        </div>
        <hr/>
        <div class="control-group">
          <label class="control-label" for="pastMedicalHistory">Past Medical History</label>
          <div class="controls">
            <textarea name="pastMedicalHistory" id="pastMedicalHistory" placeholder="Past Medical History">${result.pastMedicalHistory}</textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="pastSurgicalHistory">Past Surgical History</label>
          <div class="controls">
            <textarea name="pastSurgicalHistory" id="pastSurgicalHistory" placeholder="Past Surgical History">${result.pastSurgicalHistory}</textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="allergies">Allergies</label>
          <div class="controls">
            <textarea name="allergies" id="allergies" placeholder="Allergies">${result.allergies}</textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="familyHistory">Family History</label>
          <div class="controls">
            <textarea name="familyHistory" id="familyHistory" placeholder="Family History">${result.familyHistory}</textarea>
          </div>
        </div>
        <div class="control-group">
          <label class="control-label" for="socialHistory">Social History</label>
          <div class="controls">
            <textarea name="socialHistory" id="socialHistory" placeholder="Social History">${result.socialHistory}</textarea>
          </div>
        </div>
        <div class="control-group">
          <div class="controls">
            <input type="submit" class="btn" value="Update" />
            <input type="button" class="btn" id="client-delete-btn" value="Delete" />
          </div>
        </div>
      </form>
    </div>
    <%@include file="/commons/footer.jsp" %>
    <script src="${path}/js/vendor/bootstrap-datepicker.js"></script>
  </body>
</html>


